A randomized clinical trial to assess the efficacy of intramuscular droperidol for the treatment of acute migraine headache

Richman, Peter B.; Allegra, J.R.; Eskin, Barnet; Doran, James P.; Reischel, Ulrich; Kaiafas, Costas; Nashed, Ashraf H.

doi:10.1053/ajem.2002.30007

Cited by 53 publications

(47 citation statements)

References 25 publications

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“…Treatment with dopamine agonist can determine various responses [25]. Dopamine antagonists have been used successfully in acute migraine treatment [26], and there is evidence that alterations in dopamine may occur during migraine attacks [27]. Alteration of headache phenotypes after administration of dopamine agonists suggests that headache syndromes associated with prolactinomas may be the result of alterations in the dopamineprolactin axis rather than simply caused by the mass effects of the tumour, also because the headache begins months before hormonal symptoms for pituitary disorders appear [17,25].…”

Section: Discussionmentioning

confidence: 99%

High prolactin levels as a worsening factor for migraine

et al. 2006

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IntroductionMigraine is a very complex condition; in fact its physiopathology is not completely clear [1]. It is believed that many neurotransmitters are implicated in this process [2], and hormones have been shown to play a major role in women [3]. Among the neuroendocrinological alterations, disorders of the hypothalamic-hypophysial axis are believed to be implicated in the pathogenesis of primary J Headache Pain (2006) 7:83-89 DOI 10.1007 High prolactin levels as a worsening factor for migraine

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Section: Discussionmentioning

confidence: 99%

High prolactin levels as a worsening factor for migraine

et al. 2006

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“…14 The remaining four studies compared parenteral droperidol to a comparator drug in the treatment of migraine or benign headache. [15][16][17][18] The comparator drugs were meperidine, prochlorperazine, or olanzapine. The details of these papers are shown in Table 1 and Table 2.…”

Section: Resultsmentioning

confidence: 99%

Are butyrophenones effective for the treatment of primary headache in the emergency department?

Leong

Kelly

2011

CJEM

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Objectives: Butyrophenones have been reported to provide effective migraine relief in the emergency department (ED). We conducted a systematic review of the evidence for their use in the ED. Data source: We searched the Cochrane, Medline, Embase, and CINAHL databases. Study selection: Included studies were randomized trials of a parenteral butyrophenone (droperidol, haloperidol) versus placebo or a comparator in migraine or benign headache with results available in English. Study quality was determined using the Jadad score. Six articles were included. Data extraction: Primary outcomes were subjective or objective headache relief (. 50% improvement in visual analogue scale scores). Secondary outcomes included side effects. We reported pooled odds ratios (ORs) with their 95% confidence intervals (CIs) for subjective or objective headache relief for butyrophenones versus placebo or comparator agents. Data synthesis: Three studies reported subjective headache relief with a butyrophenone versus placebo or meperidine in migraine. Two studies reported objective headache relief with droperidol versus prochlorperazine, whereas one study compared droperidol versus olanzapine in benign headache. The pooled OR for subjective headache relief was 8.08 (95% CI 1.54-42.30) for a butyrophenone versus placebo, whereas it was 1.50 (95% CI 0.33-6.77) for droperidol versus meperidine in migraine. The pooled OR for objective headache relief was 2.96 (95% CI 1.36-6.43) for droperidol versus prochlorperazine in benign headache. Rates of side effects were 10 to 45%; akathesia and sedation were the most common. Conclusions: Butyrophenones are effective for the relief of migraine or benign headache. However, adverse effects make it difficult to recommend butyrophenones above agents with similar effectiveness and fewer problems. RÉ SUMÉObjectif : Il a é té signalé que les butyrophé nones soulageaient les migraines dans les services d'urgence. Nous avons procé dé à une analyse systé matique sur leur utilisation à l'urgence. Source des donné es : Nous avons interrogé les bases de donné es Cochrane, Medline, Embase et CINAHL. Sé lection des é tudes : Nous avons retenu les essais randomisé s d'un butyrophé none parenté ral (dropé ridol, halopé ridol) contre un placebo ou un comparateur en cas de migraine ou de cé phalé e bé nigne. Les ré sultats devaient ê tre disponibles en anglais. Nous avons é valué la qualité des essais selon le score de Jadad. Six articles ont é té retenus. Extraction des donné es : Les principaux critè res d'é valuation é taient le soulagement subjectif ou objectif de maux de tê te (. 50 % d'amé lioration selon l'é chelle visuelle analogique). Les critè res secondaires d'é valuation é taient entre autres les effets secondaires. Nous avons inclus les rapports de cotes combiné s (RC) avec intervalle de confiance à 95 % (IC) pour le soulagement subjectif ou objectif de maux de tê te pour le groupe butyrophé nones par rapport au groupe placebo ou autres comparateurs. Synthè se des donné es : Trois é tudes ont signal...

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“…Prior to the FDA's warning regarding the use of DROP, the drug was commonly used by emergency physicians in the ED for the treatment of vomiting, agitation, and headache [1][2][3][4][5]. A similar butyrophenone agent, haloperidol, is still commonly used for some of these same indications.…”

Section: Discussionmentioning

confidence: 99%

“…IM Droperidol (DROP) has been effectively used in the emergency department (ED) setting to treat these complaints [1][2][3][4][5]. When given IM, DROP's onset of action is from 3 to 10 minutes with a peak effect at 30 minutes.…”

Section: Introductionmentioning

confidence: 99%

The effect of IM Droperidol on driving performance

et al. 2006

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Objectives: Droperidol (DROP) is used in the emergency department (ED) for several indications, but its effect on psychomotor performance is unclear. The purpose of this study was to evaluate the effects of DROP, 2.5 mg intramuscular (IM), on driving performance.Methods: This was a randomized, double-blinded, two-period, placebo-controlled crossover trial that utilized a standard drivertraining program with computerized scoring. We solicited 20 paid volunteers who were pre-screened with a 12-lead EKG to evaluate QT length. For the first driving simulation, subjects were randomly assigned to receive either 2.5 mg of DROP IM or an equal volume of normal saline (NS). At least 72 hours later, the same subjects participated in a second driving simulation. For the second driving simulation, the assignment of DROP, 2.5 mg IM, or normal saline was reversed: (If a subject received DROP, 2.5 mg IM, in the first simulation, the subject received normal saline in the second simulation; conversely, if a subject received normal saline in the first simulation, the subject received DROP, 2.5 mg IM, in the second simulation). Thirty minutes later, participants drove the 20-minute simulation and received an average score based on the errors made in 4 categories: accelerating, braking, steering, and signaling. Post-testing, participants evaluated their degree of drowsiness and driving impairment using a visual analog scale and compared their perception of impairment to that caused by alcohol ingestion. Data were analyzed using analysis-of-variance, Pearson chisquare and Fischer's exact test with alpha set at p = 0.05.Results: Twenty subjects (11 males and 9 females) completed the protocol. The mean age was 30 years with a range of 20 to 46 years, and the mean weight was 80 kg. The mean driving experience was 12 years. Participants who received DROP felt significantly drowsier (38.6 mm +/− 9.0) than those receiving NS (13.2 mm +/− 9.0), the mean difference was 25.4 mm p = .009. Subjects receiving DROP were also more likely to feel that their driving would be impaired as rated on the VAS (DROP: 34.6 +/− 5.2; NS: 3.2 +/− 5.2; p = .0005), and DROP subjects reported impairment equivalent to 1-4 drinks more frequently than those receiving placebo (61% vs. 16.7%, p < .001). These subjective feelings of impairment were confirmed by their driving performance on the simulator. The mean driving score, using the driving simulator, was 68.8% with DROP vs. 73.6% with NS; p = .013.Conclusions: Subjects receiving modest doses of IM DROP report increased perceptions of drowsiness, driving impairment, and intoxication; these perceptions are confirmed on objective testing.

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A randomized clinical trial to assess the efficacy of intramuscular droperidol for the treatment of acute migraine headache

Cited by 53 publications

References 25 publications

High prolactin levels as a worsening factor for migraine

High prolactin levels as a worsening factor for migraine

Are butyrophenones effective for the treatment of primary headache in the emergency department?

The effect of IM Droperidol on driving performance

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